A prospective cohort study of healthcare visits and rehospitalizations after hospital discharge in community-acquired pneumonia

Background and objective: We aimed to identify the frequency of, reasons for and risk factors associated with additional healthcare visits and rehospitalizations (healthcare interactions) by patients with community-acquired pneumonia (CAP) within 30 days of hospital discharge. Methods: Observational analysis of a prospective cohort of adults hospitalized with CAP at a tertiary hospital (2007-2009). Additional healthcare interactions were defined as the visits to a primary care centre or emergency department and hospital readmissions within 30 days of discharge. Results: Of the 934 hospitalized patients with CAP, 282 (34.1%) had additional healthcare interactions within 30 days of hospital discharge: 149 (52.8%) needed an additional visit to their primary care centre and 177 (62.8%) attended the emergency department. Seventy-two (25.5%) patients were readmitted to hospital. The main reasons for additional healthcare interactions were worsening of signs or symptoms of CAP and new or worsening comorbid conditions independent of pneumonia, mainly cardiovascular and pulmonary diseases. The only independent factor associated with visits to primary care centre or emergency department was alcohol abuse (odds ratio [OR] = 1.65; 95% confidence interval [CI]: 1.03-2.64). Prior hospitalization (≤ 90 days) (OR = 2.47; 95% CI: 1.11-5.52) and comorbidities (OR = 3.99; 95% CI: 1.12-14.23) were independently associated with rehospitalization. Conclusions: Additional healthcare visits and rehospitalizations within 30 days of hospital discharge are common in patients with CAP. This is mainly due to a worsening of signs or symptoms of CAP and/or comorbid conditions. These findings may have implications for discharge planning and follow-up of patients with CAP.

A prospective cohort study of healthcare visits and rehospitalizations after hospital discharge in community-acquired pneumonia

Background and objective: We aimed to identify the frequency of, reasons for and risk factors associated with additional healthcare visits and rehospitalizations (healthcare interactions) by patients with community-acquired pneumonia (CAP) within 30 days of hospital discharge. Methods: Observational analysis of a prospective cohort of adults hospitalized with CAP at a tertiary hospital (2007-2009). Additional healthcare interactions were defined as the visits to a primary care centre or emergency department and hospital readmissions within 30 days of discharge. Results: Of the 934 hospitalized patients with CAP, 282 (34.1%) had additional healthcare interactions within 30 days of hospital discharge: 149 (52.8%) needed an additional visit to their primary care centre and 177 (62.8%) attended the emergency department. Seventy-two (25.5%) patients were readmitted to hospital. The main reasons for additional healthcare interactions were worsening of signs or symptoms of CAP and new or worsening comorbid conditions independent of pneumonia, mainly cardiovascular and pulmonary diseases. The only independent factor associated with visits to primary care centre or emergency department was alcohol abuse (odds ratio [OR] = 1.65; 95% confidence interval [CI]: 1.03-2.64). Prior hospitalization (≤ 90 days) (OR = 2.47; 95% CI: 1.11-5.52) and comorbidities (OR = 3.99; 95% CI: 1.12-14.23) were independently associated with rehospitalization. Conclusions: Additional healthcare visits and rehospitalizations within 30 days of hospital discharge are common in patients with CAP. This is mainly due to a worsening of signs or symptoms of CAP and/or comorbid conditions. These findings may have implications for discharge planning and follow-up of patients with CAP.

Study of tergal glands morphogenesis through an integrative analysis of genomic data

About 50% of living species are holometabolan insects. Therefore, unraveling the ori- gin of insect metamorphosis from the hemimetabolan (gradual metamorphosis) to the holometabolan (sudden metamorphosis at the end of the life cycle) mode is equivalent to explaining how all this biodiversity originated. One of the problems with studying the evolution from hemimetaboly to holometaboly is that most information is available only in holometabolan species. Within the hemimetabolan group, our model, the cock- roach Blattella germanica, is the most studied species. However, given that the study of adult morphogenesis at organismic level is still complex, we focused on the study of the tergal gland (TG) as a minimal model of metamorphosis. The TG is formed in tergites 7 and 8 (T7-8) in the last days of the last nymphal instar (nymph 6). The comparative study of four T7-T8 transcriptomes provided us with crucial keys of TG formation, but also essential information about the mechanisms and circuitry that allows the shift from nymphal to adult morphogenesis.

AltitudeOmics : Resetting of Cerebrovascular CO2 Reactivity Following Acclimatization to High Altitude.

Previous studies reported enhanced cerebrovascular CO2 reactivity upon ascent to high altitude using linear models. However, there is evidence that this response may be sigmoidal in nature. Moreover, it was speculated that these changes at high altitude are mediated by alterations in acid-base buffering. Accordingly, we reanalyzed previously published data to assess middle cerebral blood flow velocity (MCAv) responses to modified rebreathing at sea level (SL), upon ascent (ALT1) and following 16 days of acclimatization (ALT16) to 5260 m in 21 lowlanders. Using sigmoid curve fitting of the MCAv responses to CO2, we found the amplitude (95 vs. 129%, SL vs. ALT1, 95% confidence intervals (CI) [77, 112], [111, 145], respectively, P = 0.024) and the slope of the sigmoid response (4.5 vs. 7.5%/mmHg, SL vs. ALT1, 95% CIs [3.1, 5.9], [6.0, 9.0], respectively, P = 0.026) to be enhanced at ALT1, which persisted with acclimatization at ALT16 (amplitude: 177, 95% CI [139, 215], P < 0.001; slope: 10.3%/mmHg, 95% CI [8.2, 12.5], P = 0.003) compared to SL. Meanwhile, the sigmoidal response midpoint was unchanged at ALT1 (SL: 36.5 mmHg; ALT1: 35.4 mmHg, 95% CIs [34.0, 39.0], [33.1, 37.7], respectively, P = 0.982), while it was reduced by ~7 mmHg at ALT16 (28.6 mmHg, 95% CI [26.4, 30.8], P = 0.001 vs. SL), indicating leftward shift of the cerebrovascular CO2 response to a lower arterial partial pressure of CO2 (PaCO2) following acclimatization to altitude. Sigmoid fitting revealed a leftward shift in the midpoint of the cerebrovascular response curve which could not be observed with linear fitting. These findings demonstrate that there is resetting of the cerebrovascular CO2 reactivity operating point to a lower PaCO2 following acclimatization to high altitude. This cerebrovascular resetting is likely the result of an altered acid-base buffer status resulting from prolonged exposure to the severe hypocapnia associated with ventilatory acclimatization to high altitude.

Effect of supplementation with MgCO3 and L-tryptophan on the welfare and on the carcass and meat quality of two halothane pig genotypes (NN and nn)

Sixty-one animals with different Halothane genes (homozygous halothane positive, n=34; and homozygous halothane negative, n=27) were fed with three diets (controlgroup, with no supplement; magnesium (Mg) group with 1.28g MgCO3/kg and tryptophan (Trp) group with 5g L-Trp/kg) during the last 5 days before slaughter. Animals were submitted to minimal stress ante mortem conditions. Pig behaviour was recorded at the experimental farm, raceway to the CO2 stunning system and during the stunning period. Corneal reflexes were recorded after stunning as well. There were no differences in feed intake among diets (p>0.05) during the 5 days of treatment. Thehalothane positive (nn) group had lower intake than the halothane negative (NN) group(p<0.01). The behaviour of the pigs in the raceway did not differ (p>0.05) among treatments or halothane genotype. A significant (p<0.001) interaction diet*halothane was found in the time to appear the first retreat attempt during the exposure to the CO2 system. In the nn group, the time of performing the first retreat attempt was later in the Mg (p<0.05) than the Control group. Moreover, in the Mg group, the nn had a later (p<0.05) first retreat attempt than the NN. Thus, Mg supplementation could have a positive effect on welfare of nn pigs. The nn had a lower proportion of animals thatshowed corneal reflexes after stunning than NN, indicating a higher effectiveness of thestunning method in nn pigs. Neither Mg nor Trp affected carcass quality and meat quality parameters, although significant differences were found between genotypes

Assessment of air quality in Viana do Castelo, Portugal, in the scope of the polis programme

The present paper constitutes a synthesis of the results gotten during the five campaigns of air quality measurement in the years of 2003 and 2004 carried out in the Portuguese city of Viana do Castelo to characterise the reference situation and to accompany the Polis Programme, an urban re-qualification and environmental valorisation plan. The main objective of the monitoring programme consisted of the evaluation of atmospheric pollutants whose levels were susceptible of enhancement in the course of the urbanistic public works. The presented results refer to measurements performed in two distinct places of this city, comprising various consecutive days of acquisition that include, at least, one day of weekend.

Chemical stability of enalapril maleate drug substance and tablets by a stability-indicating liquid chromatographic method

The chemical stability of enalapril drug substance and tablets was studied by a stability-indicating liquid chromatographic method. Stress testing was performed on drug substance under various conditions. Accelerated stability testing was carried out for different formulations of enalapril tablets. Chromatographic separation was achieved on a RP-18 column, using a mobile phase of methanol phosphate buffer at 1.0 mL min"1 and UV detection. Degradation of the drug substance was greater under hydrolytic conditions. After 180 days of accelerated stability testing most enalapril tablets showed more than 10% of degradation. Enalapril drug substance and tablets showed instability under stress and accelerated testing respectively, with possible implications on the therapeutic activity.

Effect of population densities of Heterodera glycines race 3 on leaf area, photosynthesis and yield of soybean

The effect of Heterodera glycines on photosynthesis, leaf area and yield of soybean (Glycine max) was studied in two experiments carried out under greenhouse condition. Soybean seeds were sown in 1.5 l (Experiment 1) or 5.0 l (Experiment 2) clay pots filled with a mixture of field soil + sand (1:1) sterilized with methyl bromide. Eight days after sowing, seedlings were thinned to one per pot, and one day later inoculated with 0; 1.200; 3.600; 10.800; 32.400 or 97.200 J2 juveniles of H. glycines. Experiment 1 was carried out during the first 45 days of the inoculation while Experiment 2 was conducted during the whole cycle of the crop. Measurements of photosynthetic rate, stomatic conductance, chlorophyll fluorescence, leaf color, leaf area, and chlorophyll leaf content were taken at ten-day intervals throughout the experiments. Data on fresh root weight, top dry weight, grain yield, number of eggs/gram of roots, and nematode reproduction factor were obtained at the end of the trials. Each treatment was replicated ten times. There was a marked reduction in both photosynthetic rate and chlorophyll content, as well as an evident yellowing of the leaves of the infected plants. Even at the lowest Pi, the effects of H. glycines on the top dry weight or grain yield were quite severe. Despite the parasitism, soybean yield was highly correlated with the integrated leaf area and, accordingly, the use of this parameter was suggested for the design of potential damage prediction models that include physiological aspects of nematode-diseased plants.

Survival of Botrytis cinerea as mycelium in rose crop debris and as sclerotia in soil

Botrytis blight caused by Botrytis cinerea is an important disease of rose (Rosa hybrida) grown in greenhouses in Brazil. As little is known regarding the disease epidemiology under greenhouse conditions, pathogen survival in crop debris and as sclerotia was evaluated. Polyethylene bags with petals, leaves, or stem sections artificially infected with B. cinerea were mixed with crop debris in rose beds, in a commercial plastic greenhouse. High percentage of plant parts with sporulation was detected until 60 days, then sporulation decreased on petals after 120 days, and sharply decreased on stems or leaves after 90 days. Sporulation on petals continued for 360 days, but was not observed on stems after 150 days or leaves after 240 days. Although the fungus survived longer on petals, stems and leaves are also important inoculum sources because high amounts of both are deposited on beds during cultivation. Survival of sclerotia produced on PDA was also quantified. Sclerotia germination was greater than 75% in the initial 210 days and 50% until 360 days. Sclerotia weight gradually declined but they remained viable for 360 days. Sclerotia were produced on the buried petals, mainly after 90 days of burial, but not on leaves or stems. Germination of these sclerotia gradually decreased after 120 days, but lasted until 360 days. Higher weight loss and lower viability were observed on sclerotia produced on petals than on sclerotia produced in vitro

Control of tomato bacterial wilt through the incorporation of aerial part of pigeon pea and crotalaria to soil

The use of organic matter that improves the physical, chemical and biological soil properties has been studied as an inducer of suppressiveness to soilborne plant pathogens. The objective of this work was to evaluate the effect of different sources and concentrations of organic matter on tomato bacterial wilt control. Two commercially available organic composts and freshly cut aerial parts of pigeon pea (Cajanus cajan) and crotalaria (Crotalaria juncea) were incorporated, in concentrations of 10, 20 and 30 % (v/v), into soil infested with Ralstonia solanacearum. The soil with the fresh organic matter of pigeon pea and crotalaria was incubated for 30 and 60 days before planting. Tomato seedlings of cv. Santa Clara were transplanted into polyethylene bags with 3 kg of the planting substrate (infested soil + organic matter). The wilting symptoms and percentage of flowering plants were evaluated for 45 days. All evaluated concentrations with incorporation and incubation for 30 days of aerial parts of pigeon pea and crotalaria controlled 100% tomato bacterial wilt. With 60 days of incubation, only the 10 % concentration of pigeon pea and crotalaria did not control the disease. These results suggest that soil incorporation of fresh aerial parts of pigeon pea and crotalaria is an effective method for bacterial wilt control.

Efficiency of a yeast-based formulation for the biocontrol of postharvest anthracnose of papayas

To identify formulations of biological agents that enable survival, stability and a good surface distribution of the antagonistic agent, studies that test different application vehicles are necessary. The efficiency of two killer yeasts, Wickerhamomyces anomalus (strain 422) and Meyerozyma guilliermondii (strain 443), associated with five different application vehicles, was assessed for the protection of postharvest papayas. In this study, after 90 days of incubation at 4ºC, W. anomalus (strain 422) and M. guilliermondii (strain 443) were viable with all application vehicles tested. Fruits treated with different formulations (yeasts + application vehicles) had a decreased severity of disease (by at least 30%) compared with untreated fruits. The treatment with W. anomalus (strain 422) + 2% starch lowered disease occurrence by 48.3%. The most efficient treatments using M. guilliermondii (strain 443) were those with 2% gelatin or 2% liquid carnauba wax, both of which reduced anthracnose by 50% in postharvest papayas. Electron micrographs of the surface tissues of the treated fruits showed that all application vehicles provided excellent adhesion of the yeast to the surface. Formulations based on starch (2%), gelatin (2%) and carnauba wax (2%) were the most efficient at controlling fungal diseases in postharvest papayas.

Physiological and biochemical characterization of the assai palm (Euterpe oleracea Mart.) during seed germination and seedling growth under aerobic and anaerobic conditions

Physiological and biochemical aspects of assai palm during seed germination and early seedling growth were investigated. Seeds collected from plants growing in flooded and upland forests were used to determine the influence of normoxic (aerobic) and anoxic (anaerobic) conditions in germination and the initial and average time of development in the roots and shoots. After 75 days, seedlings germinated under normoxia were transferred to trays and submitted to flooding. Seed reserves (lipids, proteins, soluble sugars and starch) were monitored for quiescent and germinated seeds maintained under normoxic and anoxic conditions, as well as after 5, 10 and 20 days of seedling growth. Alcohol dehydrogenase (ADH) activity was quantified in roots and leaves of seedlings without or with flooding (partial and total). Seeds were not able to germinate under anoxia. Different strategies of storage mobilization of lipids, proteins, soluble sugars and starch were observed in seeds of each environment. ADH activity was induced by anoxia, with the highest level observed in the leaves. This study showed that, under normoxic conditions, the best developmental performance of assai palm seeds, from flooded or upland forest areas, during germination was associated with primary metabolites mobilization and seedling flooding tolerance with increased ADH activity. We conclude that the assai palm is well adapted to the anoxic conditions provoked by flooding.

Obstruction of drippers as a result of application of moisturized whitewash in irrigation water

Plug dynamics of non compensate drip tubes were evaluated, by the precipitation of moisturized whitewash [Ca(OH)2], which is used in the fertigation for the bulb pH control of the trademarks Azud, Amanco, Naandan, Netafim, Petroisa, Queen Gil, with flow rate varying between 0.4 to 3.0 L h-1 usually used in the country. For this matter, increasing doses of Ca(OH)² were applied in the irrigation water, from 0.01 g L-1 to 1.84 g L-1. The flow rate of each drip tube was measured in intervals of time initially of 7 days, later of 15 days of system operation, totaling a time of 100 days of operation, corresponding to nine applications or 432 hours. The coefficient of variation (CV), and relative rate flow (Qr) were evaluated. The results pointed differences among the evaluated emitter regarding the occurrence of the clogging, and the models G2 and G5 presented the smallest levels of flow rate variation comparing to the models G6, G7 and G9.

Establishment of anammox process in sludge samples collected from swine wastewater treatment system

The high load of nitrogen present in swine wastewater is one of the biggest management challenges of the activity. The Anammox process emerges as a good alternative for biological removal of nitrogen. This study aims to acclimate sludge collected from swine effluent treatment systems to establish the Anammox process. Two sludge samples were collected at Embrapa Swine and Poultry, Concordia - SC, Brazil, one from the bottom of an inactive anaerobic pond (inoculum A) and another from an aeration tank (inoculum B). Both were acclimated until the depletion of NO3-N, being subsequently inoculated in two reactors (Reactor A - Inoculum A and Reactor B - Inoculum B). The Reactor A showed activity after 110 days of operation, while the Reactor B needed 170 days. The difference in the start-up time could be explained by the different environmental conditions to which each sludge was submitted. FISH and PCR analyses confirmed the presence of microorganisms with Anammox activity, demonstrating that the sludge of swine wastewater treatment systems is a good source of inoculum for the development of the Anammox process.

Impact of elevated temperature scenarios on potato leaf development

The objective of this study was to simulate the impact of elevated temperature scenarios on leaf development of potato in Santa Maria, RS, Brazil. Leaf appearance was estimated using a multiplicative model that has a non-linear temperature response function which calculates the daily leaf appearance rate (LAR, leaves day-1) and the accumulated number of leaves (LN) from crop emergence to the appearance of the upper last leaf. Leaf appearance was estimated during 100 years in the following scenarios: current climate, +1 °C, +2 °C, +3 °C, +4 °C e +5 °C. The LAR model was estimated with coefficients of the Asterix cultivar in five emergence dates and in two growing seasons (Fall and Spring). Variable of interest was the duration (days) of the crop emergence to the appearance of the final leaf number (EM-FLN) phase. Statistical analysis was performed assuming a three-factorial experiment, with main effects being climate scenarios, growing seasons, and emergence dates in a completely randomized design using years (one hundred) as replications. The results showed that warmer scenarios lead to an increase, in the fall, and a decrease, in the spring growing season, in the duration of the leaf appearance phase, indicating high vulnerability and complexity of the response of potato crop grown in a Subtropical environment to climate change.